Compare 38571-38573 Lymphadenectomy Codes At-a-Glance to Avoid Cutting Reimbursement in Half

Fri, Apr 20, 2018


If you’re already familiar with laparoscopic bilateral total pelvic lymphadenectomy codes 38571 and 38572, you know the pattern. The second code descriptor builds on the first. When the CPT® 2018 code set added 38573, the new code descriptor followed that pattern, adding quite a few more requirements before you use the new code.

Not sure what I mean? Check out these bullet lists based on the code descriptors, and note the similarities in the first few bullets as well as differences:


  • bilateral total pelvic lymphadenectomy


  • bilateral total pelvic lymphadenectomy
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Podiatry Alert: Here’s What Caused $330 Million in Improper Payments for Part B and DMEPOS

Mon, Apr 16, 2018


We’ve talked about CERT 2017 report results before in this blog, but that’s mostly been Part B. Podiatry coders need to be thinking about DMEPOS, too. And based on the 70.5 percent error rate estimated for podiatry under DMEPOS, practices need to put that on their priority lists.

Review the CERT Report Stats

The “2017 Medicare Fee-for-Service Supplemental Improper Payment Data” report measures improper payments through the Comprehensive Error Tate Testing (CERT) program. The numbers are estimates based on a sampling of claims reviewed. The time period for …

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$30 Million in Funding for QPP Measure Development With CMS Cooperative Agreement

Thu, Apr 12, 2018


quality measure cooperative agreements

Have you heard about the CMS program to partner with stakeholders to improve quality measures in the MACRA Quality Payment Program (QPP)? Up to $30 million in funding and assistance is involved over three years.

Here Are the Target Groups and Goals

A blog post from CMS describes this measure development funding opportunity. Developing, improving, updating, and expanding quality measures are all included. CMS indicates potential partnerships with clinical specialty societies and professional organizations, patient advocacy organizations, education and research organizations, and health systems.

The stated goal is to “leverage …

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Get the Rundown on Rib Fracture ICD-10-CM Coding

Tue, Apr 10, 2018


rib ICD-10-CM codes

The terms closed and open are major players for traumatic fracture diagnosis coding. Brush up on some basics with this focus on ICD-10-CM coding for rib fracture initial encounters.

First, Find Fractures in the Index — You Know You Should!

The ICD-10-CM index provides these entries for rib under the Fracture heading:

  • Rib S22.3-
    • With flail chest – see Flail, chest
    • Multiple S22.4-
      • With flail chest – see Flail, chest.

Turn to the Tabular to See Crucial Note …

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OIG and CMS Are Both Watching Drug Specimen Validity Testing … Are You?

Fri, Apr 6, 2018


Coding for drug testing and specimen validity testing was the focus of recently released MLN Matters SE18001. At the end of the MLN article, there’s a link to an OIG report on the topic revealing millions in improper payments.

If CMS and the OIG consider something you code worthy of focus, you really should read up to be sure you understand the policy. And while you’re reading, keep in mind the larger tangle of Correct Coding Initiative (CCI) rules for drug testing codes, including proprietary lab analyses (PLA) codes, to grasp the full picture. Here are …

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A Coding Take on World Health Day, April 7

Wed, Apr 4, 2018


World Health Day 2018

The World Health Organization (WHO) uses World Health Day each April to draw attention to global health concerns. Here’s a quick history of recent World Health Day themes with a coding twist.

2018: The theme this year is “Health for All,” with discussion of paths to universal health coverage (UHC) around the world. It is a big topic that deserves more than a few sentences, but one potentially overlooked area of note is WHO’s statement that “UHC is not only about medical treatment for individuals, but also includes services for whole populations such as public health campaigns,” like “controlling the breeding grounds of mosquitoes that …

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How to Avoid a $233 Vulvectomy Coding Mistake

Fri, Mar 30, 2018


Not sure whether to report an integumentary or vulvectomy code when your ob-gyn treats a patient for a vulvar lesion? If you select the wrong code, your practice could lose out on the money it rightfully deserves.

Did you know? Vulvectomies involve much more work and therefore have higher RVUs than lesion excisions. For instance, simple, partial vulvectomy code 56620 has 14.96 total facility RVUs (national). Compare that to only 8.47 total facility RVUs for top-dollar excision code 11626 (… excised diameter over 4.0 cm). Meaning, if you report 11626 in place of 56620, you could lose out on $233 of ethical pay.

Keep the pointers below in mind when you report vulvectomy or lesion …

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Emergency Medicine Coders: Don’t Miss These 3 Trending Areas!

Wed, Mar 28, 2018


There have been some hot topics in recent issues of TCI’s Emergency Department Coding & Reimbursement Alert that are just too good not to share. Here’s a quick summary with links to the articles for you lucky readers with access to the online newsletter or to Emergency Medicine Coder.

1. Streamline With This Change to Student E/M Documentation

Teaching hospital staff got some relief from an update to CMS’s position on medical student participation in E/M service documentation. The way providers must perform encounters hasn’t changed, but the shift allows the teaching physician to “verify in the …

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Don’t Miss a Single Cognitive Care Planning Code 99483 Requirement! Take Them One at a Time

Fri, Mar 23, 2018


cognitive care planning 99483

One of the most significant changes for family medicine in 2018 is the switch from HCPCS to CPT® for behavioral health integration (BHI) and care management. In this post, we’ll check out new cognitive assessment code 99483, which not only replaced G0505, but also added 160 words to the descriptor!

Walk Through the New Code So You Don’t Miss Any Details

Here’s the 2017 descriptor for G0505 (Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or …

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Get Ready! CMS Is Introducing More Specific Pricing Modifiers for Oxygen Flow Rate

Thu, Mar 22, 2018


CMS plans to revise and introduce new pricing modifiers for oxygen flow rate. So if you submit claims for oxygen services, make sure you and your billing staff members are aware of these changes effective April 1, 2018. Here’s a heads-up!

Why the Change?

Medicare has taken this step as the existing modifiers do not meet the needs of the market. There is a need to provide greater specificity in such modifiers where there are varying prescribed flow rates.

Which New Modifiers Are Coming?

The new HCPCS modifiers you’…

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